Screening Joint Commission requires screening patients within
24 hours of admission Predetermined screening tool used Rates
potential nutritional risks
Slide 3
Potential Nutritional Risk Changes in weight Changes in
appetite Nausea Vomiting Dysphagia (difficulty swallowing) Diseases
such as diabetes, obesity, hypertension, cancer
Slide 4
Assessment Patients found to be at risk after screening should
have an assessment by a registered dietician Figure 14-1 p309 is an
example assessment chart
Slide 5
Nutritional Assessment Information Height, weight, body mass
index, weight history Lab values Food intake Potential fooddrug
interactions Chewing and swallowing ability Clients self-feed
ability Bowel and bladder function Evaluation for pressure ulcers
Food allergies and intolerances
Slide 6
More Assessment Information Food preferences:
cultural-religious beliefs Body composition Presence of burns,
trauma, infection, Physiological stressors Learning barriers:
hearing, mobility, language, vision, speech, reading/writing
skills, learning disability
Slide 7
Monitoring All patients should be monitored at appropriate
intervals
Slide 8
Items to Monitor Initial nutritional screen and/or assessment
Present body weight and weight history A record of recent food
intake and/or tolerance Any changes in medical condition Diet
orders from a physician or designee Family support
Slide 9
Nutritional Counseling All patients should be evaluated for
nutritional counseling Promotes self-care Responsibility for health
and wellness Pre-testing diets may be warranted
Slide 10
Special Diets Seek to maintain patients nutritional status
Potential to alter the following: Nutrients Calories Consistency
Fiber Fluid
Slide 11
Iatrogenic Malnutrition Refers to health care provider induced
malnutrition May be caused by: Diagnostic tests Meal schedule Lack
of appetite Drug therapy
Slide 12
Methods to Prevent Iatrogenic Malnutrition Record height/weight
Be a team player Monitor clients food intake Have knowledge about
good nutrition Monitor NPO ( Latin - nil per os)(nothing by mouth)
clients Appreciate role of nutrition in total care Recognize
signs/symptoms of malnutrition Monitor fluid intake and output
(vomiting)
Slide 13
Nutrient Delivery Methods Oral by mouth Enteral direct supply
of food into a functioning GI system through a tube NG nasogastric
ND nasoduodenal NJ nasojejunal PEG - percutaneous endoscopic
gastrostomy, the creation of a new opening in the stomach for
enteral tube feedings. PEJ used when stomach is removed Parenteral
- administered in a manner other than through the digestive tract,
as by intravenous or intramuscular injection.
Supplemental Feedings Used when patients are unable to consume
enough kilocalories In the form of solids (puddings) or liquids
(shakes)
Slide 16
Types of Supplemental Feedings Modular supplements limited
number of nutrients Standard or polymeric formulas contains all the
nutrients in a specified volume Elemental and semi-elemental
formulas nutrients are in their simplest easily absorbable form
Disease-specific formulas for people with diabetes, kidney, or
liver disorders.
Slide 17
Enteral Tube Feedings Osmolality basically compared to isotonic
food Administration of medications to a tube-fed client Monitoring
the tube-fed client Home enteral nutrition
Slide 18
Types of Administration of Enteral Feedings Continuous feeding
recommended for feedings going directly to the small intestine
Intermittent feeding Bolus feeding
Slide 19
Parenteral Nutrition Peripheral parenteral nutrition (PPN)
Total parenteral nutrition: Insertion and care of the TPN line
Monitoring Transition and combination feedings Home parental
nutrition Central parenteral nutrition inserted into a central
vein. If a peripheral line is threaded into the subclavian or
jugular vein it is called a PICC line